From the Guidelines
The recommended treatment for latent tuberculosis infection is a once-weekly isoniazid and rifapentine combination for 12 weeks (3HP regimen), which offers excellent completion rates due to its shorter duration, as supported by the most recent guidelines from the National Tuberculosis Controllers Association and CDC in 2020 1.
Treatment Options
The treatment options for latent tuberculosis infection (LTBI) include:
- 3 months of once-weekly isoniazid plus rifapentine, which is a preferred regimen due to its high effectiveness and shorter treatment duration 1
- 4 months of daily rifampin, which is also a preferred regimen with moderate evidence of effectiveness 1
- 3 months of daily isoniazid plus rifampin, which is a preferred regimen but with conditional evidence of effectiveness, particularly in HIV-positive individuals 1
- Daily isoniazid monotherapy for 6-9 months, which is an alternative regimen with higher toxicity risk and lower treatment completion rates than the preferred rifamycin-based regimens 1
Treatment Selection
Treatment selection should consider drug interaction potential, especially with rifamycins, and patient-specific factors such as HIV status or exposure to drug-resistant TB 1.
Monitoring and Side Effects
Before starting treatment, active TB must be ruled out through symptom screening, chest X-ray, and sometimes sputum testing. Regular monitoring for side effects is essential, particularly hepatotoxicity with isoniazid 1.
Importance of Treatment
Treating LTBI is crucial as it eliminates dormant TB bacteria before they can activate, reducing the risk of developing active, contagious TB disease by 60-90% and preventing further transmission in communities 1.
From the FDA Drug Label
PRIFTIN is indicated for the treatment of latent tuberculosis infection (LTBI) caused by M. tuberculosis in combination with isoniazid in patients 2 years of age and older at high risk of progression to TB disease. Latent tuberculosis infection: PRIFTIN should be administered in combination with isoniazid once weekly for 12 weeks as directly observed therapy.
The recommended treatment for latent tuberculosis (TB) is PRIFTIN (rifapentine) in combination with isoniazid, administered once weekly for 12 weeks as directly observed therapy 2.
- The dose of PRIFTIN is based on weight, with a maximum recommended dose of 900 mg once weekly.
- Isoniazid is administered at a dose of 15 mg/kg (900 mg maximum) for adults and children ≥12 years, and 25 mg/kg (900 mg maximum) for children 2 to 11 years.
From the Research
Treatment Options for Latent Tuberculosis
The recommended treatment for latent tuberculosis (TB) infection varies, with several options available. These include:
- 9 months of isoniazid (INH) daily, which has an efficacy of more than 90% if completed properly 3
- 4 months of rifampin, which has been found to have significantly better completion rates and less toxicity, especially hepatotoxicity, compared to 9 months of INH 3, 4
- 3 months of rifapentine and isoniazid, given once weekly, which has been shown to be as effective as 9 months of INH alone in preventing tuberculosis, with a higher treatment-completion rate 5
- 2 months of rifampin and pyrazinamide, which has excellent efficacy in experimental studies and randomized trials, but is associated with an unacceptably high rate of severe liver toxicity in non-HIV-infected adults 3
Comparison of Treatment Regimens
Studies have compared the efficacy and safety of these treatment regimens, including:
- A systematic review of adverse events of rifapentine and isoniazid compared to other treatments for latent TB infection, which found that the adverse event profile of INH/RPT-3 appeared generally favorable 6
- A randomized trial comparing 4 months of rifampin with 9 months of INH, which found that the 4-month regimen was not inferior to the 9-month regimen and was associated with a higher rate of treatment completion and better safety 4
- An observational study of short-course therapy for treatment of latent TB infection, which found that treatment completion rates were significantly higher with short-course regimens compared to the INH regimen 7
Adverse Events and Safety
Adverse events and safety profiles vary among the treatment regimens, with: